Collaborations

The NTASM and the Australian and New Zealand College of Anaesthetists (ANZCA) now collaborate in the collection of anaesthetic-related surgical mortality.

NTASM is notified by the hospital of all deaths that occurred during a surgical admission, see flowchart.

An anaesthetist may be involved when the treating surgeon alerts the possibility of an anaesthetic component of the death. The inclusion criteria are:

• Was there an anaesthetic component to the death : Yes or Possibly
• Was death within 48hrs of last anaesthetic: Yes

In which case, NTASM will send an anaesthetic case form (PDF 1.69MB) to the treating anaesthetist for completion. An Anaesthetist may also self-report a case if they wish.

An anaesthetic case form is:

1. completed by the consultant anaesthetist or registrar (under supervision);
2. returned to NTASM by email
3. de-identified and sent to a first-line assessor (a consultant anaesthetist; different hospital) for anonymous peer review. The de-identified surgical case form is also sent to the assessor.

If a second-line assessment (case note review) is not requested by the first-line assessor, the original anaesthetist will be sent written feedback at this point (and the case will be closed).

If a second-line assessment (case note review) is requested by the first-line assessor (that is, the case needs further investigation OR insufficient information has been provided on the case form then these steps are followed:

1. an appropriate second-line assessor is selected;
2. medical records are requested by NTASM project staff;
3. the second-line assessor reviews the Anaesthetic Case Form the patient's medical records and the first-line assessor's comment, before writing a one-page report;
   Note: The review is carried out and the report written in a spirit of sympathetic enquiry;
4. the report and relevant feedback is sent to the reporting anaesthetist. The case is then closed, and
5. at each stage of the process the reporting anaesthetist has right of reply.